Retrospective analysis of children diagnosed with Kawasaki disease

Abstract

Background/aim The aim of our study was to evaluate the long-term impacts of Kawasaki disease on our patients regarding coronary involvement demographic characteristics, treatment regimens, and clinical course. Materials and methods Our study included 104 patients diagnosed and hospitalized with Kawasaki disease in our center, from January 2004 to January 2019. In our study, patients were divided into three groups according to coronary artery involvement. Patients in group 1 had no echocardiographic findings, while the ones in group 2 had coronary artery dilatation and ones in group 3 had coronary artery aneurysm (CAA). Results Among 104 patients, the median age was 9.15 (3.0–22.0) years, and 61 of the patients were male while 43 of the patients were female. With a wide range of 1.50–16.50 years of follow-up time, the median diagnosis age of our patients was 31 months (3.0–164.0). Fever duration (median day 10 (5–21), p = 0.025) was statistically significantly higher in group 3. Blood C-reactive protein (CRP) levels, white blood cell (WBC) counts, and neutrophil counts were significantly higher in group 3. There was a statistically significant difference between patients in group 3 and group 2 in which the lowest strain deformation values were in the patients of group 3. In contrast to group 1, the time for initiation of IVIG therapy is significantly prolonged both in group 2 (median: 9.5 days, p = 0.028) and group 3 (median: 10 days, p = 0.036). Conclusion In our study, serum CRP levels, WBC count, and neutrophil count were higher in patients with coronary artery abnormalities, in agreement with the previous studies. In the light of our results, we consider that the most important determining factor for the development of coronary artery aneurysm is the time of intravenous immunoglobulin (IVIG) administration.

Hypovitaminosis D and Leukocytosis to Predict Cardiovascular Abnormalities in Children with Kawasaki Disease: Insights from a Single-Center Retrospective Observational Cohort Study

“…About 10–20% of patients with KD are nonresponsive to IVIGs, requiring secondary treatments, and may display an increased risk of CVAs: their early identification is critical to reinforce the standard initial approach to such patients, but all available scoring systems are unsuitable in non-Japanese populations [ 15 ]. We previously found that higher CRP values and younger age at KD onset were associated, respectively, with a failure in IVIG response and a higher risk of CVAs [ 16 ]. Additionally, the exact risk of developing cardiovascular events after KD remains undefined, warranting preventive counseling and regular cardiovascular surveillance in all children with a history of previous KD, aiming to mitigate the risk of eventual adult-onset cardiovascular diseases [ 17 ].…”

The incidence of periungual desquamation and thrombocytosis in Kawasaki disease and the importance of systematic observation in the subacute phase

“…Previous studies have not established a clear correlation between desquamation, coronary anomalies, and thrombocytosis with coronary anomalies. Some papers have reported no association, while others suggest that more severe desquamation may correlate with fewer coronary complications, and increased thrombocytosis may be associated with a higher incidence of coronary complications ( 6 , 10 , 24 , 25 , 34 ). Our study has limitations in discussing the correlation between desquamation, thrombocytosis and coronary artery complications, and the outcomes of early treatment.…”

Exploring the diagnostic value of CLR and CPR in differentiating Kawasaki disease from other infectious diseases based on clinical predictive modeling

“…Ultrasound findings of typical coronary artery abnormalities are also an important indicator for diagnosing KD, but CAL tends to be delayed, which makes diagnosing KD with ultrasound lagging behind, and the optimal window of time for initial IVIG therapy in KD is within 10 days of onset, with delayed treatment leading to increased risk of drug resistance and CALs (8,9). A recent study in Turkey also showed that prolonged duration of IVIG treatment is the most important determinant of the occurrence of CAL (10). Therefore, in order to avoid underdiagnosis and misdiagnosis of KD, new diagnostic markers should be actively developed on the basis of clinical presentation and cardiac ultrasound.…”